Above is an example of a question you may face in your UCAT exam whilst tackling the Situational Judgement section.
Have a go at answering it by looking at the potential courses of action below, and think about which would be best one to pursue and which wouldn’t.
Which of the following would be an appropriate response to the situation? (there may be more than one)
1. Close the patient notes and leave Mrs Jones, saying you will review her in the morning as you have a social engagement to get to.
2. Demand the nurses administer the painkillers and then leave for the night.
3. Discuss with the Nurse in charge her reasons for not administering the medication.
4. Cancel the prescription as clearly the painkillers weren’t needed if they weren’t given.
5. Review Mrs Jones case to assess whether or not she needs painkillers prescribed.
6. Seek advice from your registrar.
1. Close the patient notes and leave Mrs Jones, saying you will review her in the morning as you have a social engagement to get to. Very Inappropriate
2. Demand the nurses administer the painkillers and then leave for the night. Very Inappropriate
3. Discuss with the Nurse in charge her reasons for not administering the medication. Very Appropriate
4. Cancel the prescription as clearly the painkillers weren’t needed if they weren’t given. Inappropriate
5. Review Mrs Jones case to assess whether or not she needs painkillers prescribed. Very Appropriate
6. Seek advice from your registrar. Appropriate
This scenario addresses the issue of compromising of patient safety due potentially ineffective MDT (Multidisciplinary Team) communication and is something which is commonly assessed within the SJT and Medical School.
Ensuring patient safety is above all the most important role as a doctor and therefore staying a little longer is something which must be done. It is very important to discuss with the nursing staff their reasons for not administering the drug as they may have noted something you missed when first reviewing Mrs Jones.
In light of this, it would also be very appropriate to review Mrs Jones’ case again to ensure you covered all aspects in the case, before deciding on whether or not to proceed with the prescription of painkillers.
Although you may have missed something within the case, it is also a possibility the nurses did not see your prescription or forgot to administer it.
Therefore, leaving without taking any action puts Mrs Jones’ safety and comfort at risk. It therefore would also be very inappropriate to simply cancel the prescription without first consulting the nurse as this may also compromise Mrs Jones’ safety and/or comfort.
In order to maintain a good working relationship within your MDT it is important to show respect and consideration to the rest of your colleagues.
The nature of how we communicate with our colleagues can impact the working of the team and therefore it is never appropriate to use terms such as demand, threaten, blame or accuse when considering professional communication.
You must take prompt action if you think that patient safety, dignity or comfort is or may be seriously compromised. – GMC Good Medical Practice
As a medical student or doctor, it is your duty to ensure patient safety, comfort or dignity is not compromised and therefore any SJT scenarios which indicate that this might be the case require immediate and prompt action. There are a number of ways patient safety and/or comfort can be compromised:
If a patient is not receiving basic care to meet their needs, then someone who can act straight away must be informed of the situation.
If patients are at risk due to inadequate facilities or equipment, resources or premises then the matter must be put right immediately using your individual workplace guidance or policies.
Lastly if a patient is at risk due to concerns over a colleague not being fit to practice, you must seek advice – from a colleague, your defence body or the GMC.
[All taken from GMC Good Medical Practice – Safety and Quality]
Alongside this as a doctor you have a duty to offer help if emergencies arise, in both clinical and community settings – whilst also considering your own safety. If you are ever in doubt, seek help from a senior colleague who will be able to advise on the situation, seeking help when you are uncertain is NOT a negative trait!
Can you think of other examples where patient safety may be compromised? How would you manage these situations as a FY1 doctor?
Have you ever witnessed an emergency arise (either within a clinical or community setting)? How did the doctors present respond?
Written by Joely Hawkes
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